Inspection·November 10, 2022

F 0583 included providing privacy for the resident. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 2 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good nutrition for 1 of 9 (Resident #56) residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure Resident #56 meal was set up and within his reach. These failures could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for weight loss and a decreased quality of life. Findings include: Review of Resident #56's face sheet dated 11/10/22 reflected he was a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included dementia, UTI, hypernatremia (elevated sodium), and constipation. Resident #56's quarterly MDS dated [DATE] reflected he had a BIMS score of 4 which indicated a severe cognitive impairment. The assessment of his functional status reflected he required limited physical assistance from one person with eating. Review of Resident #56's care plans dated 11/10/22 reflected Resident #56 had a hearing, visual, and speech deficit. He had a self-care deficit and required total assistance. Resident #56 had an altered nutritional status due to being bedridden and dementia. Interventions included assisting him with eating and providing the necessary assistance with food and fluids. Resident #56's nutritional assessment dated [DATE] completed by RD G observed his lunch on 11/01/22. She documented Resident #56 was in bed and appeared to have slight muscle wasting. She also documented Resident #56 had slid down, was leaning to his left side, and was unable to reach his food and fluids. RD G documented once he was repositioned, he was able to finish his meal. RD G documented nursing was to consult PT and/or OT to evaluate for proper positioning during mealtimes. In an observation on 11/10/22 at 8:40 AM, Resident #56 was lying in bed, awake and alert. His breakfast meal tray was in his room, on his bedside table, covered. A fall mat was on the floor between the resident and his bedside table, and his meal was out of his reach. In an observation and interview on 11/10/22 at 9:20 AM, Resident #56's breakfast tray was still out of his reach. He stated he had not eaten breakfast and wanted cereal. HHSC Surveyor intervened and asked the Regional Nurse if she could help Resident #56. The Regional Nurse said she did not want to assume staff had left the meal tray and would not be back to assist Resident #56 with his breakfast. LVN D arrived to Resident #56's room and stated Resident #56 was able to feed himself but required his meal be set up. LVN D and CNA F repositioned Resident #56 higher in his bed, placed his bedside table and breakfast over his bed and opened his drinks. Resident #56 was then able to feed himself. In an interview on 11/10/22 at 9:45 AM, NS H said she helped pass Resident #56's meal tray. NS H said she was not aware which residents required assistance with their meals or the type of assistance they required. NS H said the nurse would tell her what to do. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 3 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm In an interview on 11/10/22 at 2:28 PM, LVN D said Resident #56's breakfast should have been placed at his bedside because he could eat by himself. She said the containers also needed to be opened for him. LVN D said it was her responsibility to tell the nursing students the type of assistance residents required for meals. LVN D said she should have told NS H she needed to set up Resident #56's meal, but she thought she knew. Residents Affected - Few In an interview on 11/10/22 at 3:12 PM, DON E said it was the floor nurses' responsibility to give the nursing students instructions on how to provide care for a resident. DON E said it was her expectation CNAs and the nurses on the hall should be passing out the trays with the nursing students. DON E said if a resident did not get the assistance they needed with meals that could cause weight loss. Review of the facility's policy titled, Assisting Residents with Eating, dated 02/12/20, reflected the policy did not address assisting residents who required meal set up. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 4 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #56) of 3 residents reviewed for quality of care. Residents Affected - Few The facility failed to ensure Resident #56's heels were offloaded and a dressing was in place to his arterial wound. This failure placed residents with wounds at risk for worsening wounds, infections, bleeding, or pain. Findings included: Review of Resident #56's face sheet dated 11/10/22 reflected he was a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included dementia. Resident #56's quarterly MDS dated [DATE] reflected he had a BIMS score of 4 which indicated a severe cognitive impairment, he required extensive assistance from two staff for bed mobility, dressing, and personal hygiene. The skin section reflected he did not have any pressure wound, ulcers, or skin problems and treatments included a pressure reducing device for his bed and application of dressings to his feet. Review of Resident #56's care plans dated 11/10/22 reflected Resident #56 had osteomyelitis to his heel, a hearing, visual, and speech deficit. He had a self-care deficit and required total assistance. Resident #56 had an altered nutritional status due to being bedridden and dementia. Interventions included IV antibiotics, inspecting his skin daily with care and bathing, offloading his heels, positioning the resident properly, and treatments and dressings as ordered. Review of Resident #56's orders dated 11/10/22 reflected his diagnosis of acute osteomyelitis (infection in the bone) to the right ankle and foot and the following orders: 1. 10/26/22- May have multi-podus boot (device that alleviates pressure to heel and supports leg position) to bilateral feet every shift. 2. 11/09/22- Treatment to left heel arterial wound every morning shift; cleanse with normal saline, pat dry, apply skin prep, and leave open to air. 3. 11/09/22- Treatment to right heel arterial wound every morning shift; cleanse with normal saline, pat dry, apply Santyl, apply calcium alginate with silver, and cover with superabsorbent silicone border and faced dressing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 5 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation and interview on 11/08/22 at 10:39 AM reflected Resident #56 was lying in bed with his eyes closed. He did not respond to questions. His heels were not offloaded, and he had slid down in bed. His heels were resting on top of the foot board. There was one foot pillow on the resident's bed lying to the left of him, but not applied. An observation and interview on 11/10/22 at 9:09 AM reflected Resident #56 was lying in bed, awake and alert. He had slid down in bed and the bottom of his feet, including his wounds, were pressed up against the foot board. There was not a dressing in place to the wounds to his left or right heels. There was a streak of dry, rust colored substance on his sheet by his right leg which appeared to be dry blood. Resident #56 denied pain and said he was not aware he was supposed to get a treatment to his legs. An observation and interview on 11/10/22 at 9:20 AM reflected Resident #56 had slid down in his bed and his heels were on top of the foot board. LVN D and CNA F entered and repositioned Resident #56 higher in bed and he began to eat his breakfast. LVN D said Resident #56 had a treatment ordered for both his heels and she said she had not been notified Resident #56's dressing to his heel was not in place. His heels were not offloaded when he was repositioned. An observation on 11/10/22 at 09:47 AM, reflected Resident #56 had again slipped down in bed and his right heel was on the foot board, his left foot was crossed over his right foot. There was not a dressing in place. In an observation on 11/10/22 at 10:29 AM, LVN D entered Resident #56's room and completed the treatment to both his heels. A dressing was applied to both heels, his feet were offloaded on a pillow, and a foot pillow was applied to his right foot. LVN D also inserted a foam wedge between Resident #56's mattress and foot board. In an interview on 11/10/22 at 2:28 PM, LVN D said Resident #56's wounds to his heels were getting smaller. LVN D said any staff who observed there was not a dressing to his heels or his heels were not offloaded should notify the nurse. LVN D said interventions for Resident #56's wounds included nutritional supplements, the foam wedge to keep his feet off the foot board, checking on him at least every 2 hours to make sure he was positioned appropriately, and she said he only had one foot pillow for his right foot. LVN D stated if the wound treatment for Resident #56 and offloading his heels were not done, his wounds could get worse. In an interview on 11/10/22 at 3:12 PM DON E said Resident #56 moved a lot in bed and he had a history of falls. She said staff should be making rounds on him every 2 hours to ensure he was positioned appropriately. DON E did not state the risk of Resident #56's heels and wounds not being offloaded. Review of the facility's policy, Treatment of Wounds: Dressing Changes . dated 07/2018, reflected the policy did not include interventions for the prevention of pressure wounds. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 6 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that one (Resident #91) of 2 residents reviewed for urinary catheters received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible. The facility failed to care for Resident #91 indwelling urinary catheter when it was found with a large amount of pale-yellow sediment in the tube and murky amber urine in the urinary drainage bag and the drainage bag was on the floor. This deficient practice could affect residents in the facility with indwelling urinary catheters and place them at risk for infection and not receiving services as needed. Findings included: Review of Resident #91's face sheet dated 11/10/22 reflected he was an [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included dementia, chronic kidney disease, urine retention, and history of UTI. Review of Resident #91's MDS dated [DATE] reflected he had a BIMS score of 8 which indicated a moderate cognitive impairment. The assessment of his functional status reflected he required extensive 2-person physical assistance with toileting. The bowel and bladder assessment reflected he had an indwelling catheter and was frequently incontinent of bowel. Review of Resident #91's care plans dated 11/10/22 reflected he had a urinary catheter and complications can include an increased risk if UTI, blockage of the catheter . Interventions were to care/change of urinary catheter as ordered . monitor urine appearance, amount, odor, clarity. Review of Resident #91's consolidated orders dated 11/10/22 the following orders: 1. 07/26/22- change foley catheter as needed (clogged, dislodged, or as clinically indicated). CDC recommendation: Change catheters and drainage bags based on clinical indications such as infection, obstruction, and when the closed system is compromised. 2. 08/01/22- Check output every shift. 3. 11/10/22- Check foley catheter and urine every shift for appearance (clear/yellow, amber, cloudy/sediment) Notify physician if any abnormalities. Check patency. Document abnormal findings in nurses' notes and notify physician. 4. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 7 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 11/10/22- Suprapubic flush as needed every 24 hours with 30mL of sterile water for urinary retention and sediment. 5. 11/10/22- Foley catheter 16 FR every shift to continuous gravity drainage and catheter care. Privacy bag checked and placement of leg strap verified every shift. Review of Resident #91's nurses' note dated 08/01/22 reflected his foley catheter was changed on 08/01/22 because the catheter was coated with white sediment, draining sluggishly, and was not patent. In an interview and observation on 11/08/22 at 10:42 AM Resident #91 was lying in bed. He had an indwelling foley catheter which was hanging off the bed. The drainage bag was covered with a privacy bag, but the drainage tubing was coated with pale yellow sediment. Resident #91 said he had a foley catheter due to a stroke. Resident #91 said his foley catheter was last changed on 06/01/22 and the nurse told him the catheter would be changed when the nurse thought it needed to be changed. In an interview and observation on 11/10/22 at 8:40 AM Resident #91 was lying in bed. His foley catheter drainage bag did not have a privacy bag and was on the floor. The drainage tubing was coated with pale yellow sediment and there was a large clot of sediment in the tubing. The urine in the drainage bag was dark amber and contained a large amount of pale-yellow sediment. ADON B entered the room. She stated the foley drainage bag should not be on the floor. ADON B stated Resident #91's foley catheter tubing and drainage bag had sediment and stated she would call the physician. ADON B said CNAs were responsible for emptying the catheter drainage bags every shift and as needed. In an interview on 11/10/22 at 9:15 AM, ADON B said she received an order from the physician to flush Resident #91's foley catheter and obtain urine to test for a UTI. In an interview on 11/10/22 at 9:40 AM, DON C said she was at the facility helping out and said Resident #91's foley catheter would be flushed as ordered by the physician. DON C said per the CDC, foley catheters were only changed as needed, not routinely. DON C said a foley catheter would be changed if the resident displayed signs of infection, such as sediment in their urine. DON C then said Resident #91's foley catheter would be replaced and then flushed. In an interview on 11/10/22 at 2:28 PM, LVN D said she was assigned to Resident #91 on 11/07/22, 11/08/22, 11/09/22, and 11/10/22 on the 6AM to 2PM shift. LVN D said she observed residents' foley catheters every day in the morning, at the end of her shift, and as needed. LVN D said she had not noted Resident #91 had sediment in his foley catheter tube. LVN D said CNAs emptied the catheter drainage bags, gave her the amount, and were supposed to tell her if there was a change in the urine color or clarity. LVN D said sediment could be an indication of a resident not getting enough fluids or an infection. LVN D said indwelling catheters were not changed unless there's a problem, like if he's had a change in condition like the sediment today. Review of the facility's policy titled, Care and Removal of an Indwelling Catheter, dated revised 01/12/20 reflected the policy did not address routine care, monitoring, and placement of foley catheters and drainage system nor indications of when a foley catheter should be replaced. Review of the CDC's recommendations for urinary catheters accessed at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 8 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html on 11/16/22 reflected: Level of Harm - Minimal harm or potential for actual harm .Do not rest the bag on the floor . Changing indwelling catheters or drainage bags at routine, fixed intervals is not recommended. Rather, it is suggested to change catheters and drainage bags based on clinical indications such as infection, obstruction, or when the closed system is compromised . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 9 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for 1 (Resident #8) of 2 residents reviewed for enteral nutrition. The facility failed to ensure Resident #8's feeding bag was labeled. This failure could result in complications of enteral feedings such as receiving the wrong feeding or outdated feeding. Findings included: Review of Resident #8's face sheet dated 11/10/22 reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included dementia and difficulty swallowing following a stroke. Review of Resident #8's MDS dated [DATE] reflected she had a severe cognitive impairment, was totally dependent on staff for eating, she had a feeding tube, and she received 51% or more of nutrition and fluids through her tube feeding. Review of Resident #8's care plans, dated 11/09/22, reflected she had altered nutrition due to enteral feeding. Interventions included keeping the head of bed elevated, monitoring tolerance of tube feeding, providing water flush as ordered, providing water flushes at medication pass per nursing policy, and providing tube feedings as prescribed. Review of Resident #8's orders dated 11/09/22 reflected an order for Isosource (type of enteral formula) at 55mL per hour over 22 hours. In an observation and interview on 11/08/22 at 10:15 AM, Resident #8 was lying in bed. She could not answer questions. Resident #8 had an enteral feeding pump at her bedside which was running into her g-tube. The feeding pump had 2 bags hanging; one had a clear liquid, and the second had a tan colored liquid. Neither bag had labels with contents, date it was hung, or the resident's name. In an observation and interview on 11/09/22 at 7:22 AM, LVN D and ADON B were in Resident #8's room to administer her medication. Resident #8 had an enteral feeding pump at her bedside which was running into her g-tube. The feeding pump had 2 bags hanging; one had a clear liquid, and the second had a tan colored liquid. Neither bag had labels with contents, date it was hung, or the resident's name. LVN D said she had not noted Resident #8's feeding bag was not labeled. LVN D said the feeding bag should be labeled with the formula, date it was hung, the rates, and the resident's name. In an interview on 11/09/22 at 10:05 AM, DON E said enteral feeding bags should have a label which included the date, initials of nurse who hung it, and the time. DON E said Resident #8's feeding did not run for a long period so she did not believe there would be an issue with the feeding hanging longer that indicated if it was not labeled. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 10 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled Enteral Nutrition . dated 01/12/20, reflected the procedure included labeling the formula container with the resident's name, room, date, starting time, rate, and the initials of the person setting it up. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 11 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (Resident #8) of 6 residents reviewed for pharmaceutical services. The facility failed to ensure LVN D flushed Resident #8's g-tube between medications as ordered. This failure could lead to medication interactions for residents who receive their medications enterally. Findings included: Review of Resident #8's face sheet dated 11/10/22 reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included dementia and difficulty swallowing following a stroke. Review of Resident #8's MDS dated [DATE] reflected she had a severe cognitive impairment, was totally dependent on staff for eating, she had a feeding tube, and she received 51% or more of nutrition and fluids through her tube feeding. Review of Resident #8's care plans, dated 11/09/22, reflected she had altered nutrition due to enteral feeding. Interventions included keeping the head of bed elevated, monitoring tolerance of tube feeding, providing water flush as ordered, providing water flushes at medication pass per nursing policy, and providing tube feedings as prescribed. Review of Resident #8's orders dated 11/09/22 reflected an order entered on 09/05/21 to flush her g-tube with 30mL of water before and after medications and with 15mL of water between each medication administered. In an observation and interview on 11/09/22 at 7:22 AM, LVN D administered Resident #8's medications via her g-tube. LVN D flushed Resident #8's g-tube with 30mL of water before medications and after all medications. LVN D did not flush Resident #8's g-tube between each medication. LVN D said she did not flush Resident #8's g-tube between each medication because Resident #8 did not have an order to flush between each medication. In a follow-up interview on 11/09/22 at 9:42 AM, LVN D said she misread Resident #8's flush orders and thought it was to only to flush before and after, but not in between each medication. LVN D said water flushes in between medications were to ensure the medication was cleared through the tube and there were not any medication interactions. In an interview on 11/09/22 at 10:05 AM, DON E said she expected nurses to review physician's orders prior to medication administration. DON E said the purpose of flushing the g-tube between each medication was to make sure it the medication went all the way through the g-tube. Review of the facility's policy titled Medication Administration Enteral Tubes, dated 09/18, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 12 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm reflected, .Enteral tubes are flushed with at least 15mL of water before administering any medications and after all medications have been administered. Each medication is administered separately to avoid interaction and clumping. The enteral tubing is flushed with water between each medication to avoid physical interaction of the medications . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 13 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food safety in the facility's only kitchen. Residents Affected - Some The facility failed to ensure food items in the dry storage, refrigerator, and freezer were labeled, dated, and sealed properly. These failures could affect residents by placing them at risk for food-borne illness. Findings included: Observation of dry storage goods area on 11/08/22 at 9:45 am revealed what appeared to be flour in a large plastic container with the lid pushed back half-way exposing the food substance, and 4 packs of hamburger buns not dated/labeled. Observation of the walk-in refrigerator on 11/08/22 at 9:55 am revealed what appeared to be the following items: * green peas in a large plastic bin with lid that was not sealed/dated, *Baked beans in large container not labeled/dated, * A plastic bag of pound cake that had been opened with no dates, * A large baggie of chicken with a use by date 11/05/22 (expired) * A large baggie of ham sandwich meat unsealed/opened/exposed to the air and not dated/labeled, * A large baggie of yellow shredded cheese not labeled/dated, * A large baggie of yellow cheese slices not labeled/dated, and * A large baggie of shredded white cheese not labeled/dated. Observation of the walk-in freezer on 11/08/22 at 10:10 am revealed the following items: * A bag of carrots opened/unsealed/and not labeled, *A large baggie of an unknown frozen food item with a use by date of 8/16/2022, and *A large baggie of an unknown frozen food item with a used by date of 11/05/2022. Observation on 11/09/22 at 10:15 am revealed in the dry storage 3 large bags of ketchup not dated/labeled. Observation on 11/09/22 at 10:20 am in the stand-alone refrigerator there were approximately 35 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 14 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some small individual containers stored in a large metal container with shredded cheese, butter, mustard, and other unidentified condiments not labeled/dated. Interview with the Dietary Manager and Regional Dietitian on 11/09/22 at 2:00 pm revealed they are aware all food items must be sealed, labeled, and dated appropriately. The Dietary Manager stated he was responsible for making sure all tasks are completed in the kitchen by his staff including all food items in the dry storage, refrigerator, and freezer being sealed, labeled, and dated appropriately. He also stated if all food items are not sealed, labeled, dated, and expired items not thrown out, it could put residents at risk for food-borne illness. Review of the facility's policy titled Food Storage, dated August 1, 2018 reflected .Policy: Sufficient storage facilities are provided to keep foods safe, wholesome, and appetizing. Food is stored, prepared, and transported at an appropriate temperature and by methods designed to prevent contamination .Procedure: 1. Storeroom: Air-tight containers or bags are used for all opened packages of food. All containers are accurately labeled with the item and date opened .canned and dry foods without expiration dates are used within six months of delivery .2. Refrigerator: All foods are covered, labeled, and dated .3. Freezer: Foods are covered, labeled, and dated .Any item out of the original case must be properly secured and labeled. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 15 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain an infection control policy and procedure designated to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 2 ( CNA A and CNA F) of 8 staff observed for infection control. Residents Affected - Some The facility failed to ensure CNA A and CNA F doffed their dirty gloves after incontinent care. These failures placed residents at risk for spread of infection through cross-contamination. Findings included: In an observation on 11/08/22 at 10:05 AM, CNA A was at Resident #5's bedside providing incontinent care. CNA A did not doff her dirty gloves after cleaning the buttocks or before applying the clean brief. CNA A then took the dirty brief to the restroom and disposed of it in the trash can. CNA A, still wearing the dirty gloves, touched Resident #5's sheets and pulled them over her, touched the bed control and adjusted the head of the bed, and touched Resident #9's bedside table, moving it closer to Resident #9. In an interview on 11/08/22 at 10:15 AM, CNA A said it was her first day at the facility. CNA A said she should have doffed her dirty gloved after she disposed of the dirty brief because she could infect the clean stuff with the dirty gloves. In an observation on 11/10/22 at 10:31 AM, CNA F provided incontinent care for Resident #56. After incontinent care, using the same gloves she had used to clean the resident's genitals, CNA F placed the clean brief on Resident #56. CNA F then placed a pillow under Resident #56's feet, pulled the blanket over him, and touched the bed controller to lower the bed. CNA F then left the room with the trash and wearing one dirty glove to hold the trash. In an interview on 11/10/22 at 11:22 AM, CNA F said she was an agency aide, and it was her first shift at the facility. CNA F said she should have doffed her dirty gloves after incontinent care and before touching clean items because she could spread germs and cause contamination. In an interview on 11/09/22 at 10:05 AM, DON E said hand hygiene should be done prior to incontinent care, if hands get soiled, and after they are finished. DON E said dirty gloves should not be used to touch clean items for infection control and said they did not want to spread germs. Review of the facility's policy titled Hand Hygiene for Staff and Residents, dated 07/2018, reflected hand hygiene should be done after contact with soiled or contaminated articles (such as articles that were contaminated with body fluids), resident contact, and removal of medical gloves. The policy did not indicate when staff should remove gloves. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 16 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store, prepare, and serve water in accordance with professional standards for a sanitary environment and water safety for two (600 hall hydration ice chest and nourishment room ice machine) of two locations reviewed for sanitary conditions. 1. The facility failed to ensure the hydration ice chest located on the 600 Hall was clean and free of mold, mildew, grime, spilled juices, and coffee or tea that were served to resident for hydration and consumption. and use of proper ice scoops utensils for ice. 2. The facility failed to ensure the ice machine, in the facility nourishment room was cleaned and free of limescale and lime (chalky white spots) on the inside of the ice machine rims, ice scoop was secure and properly covered to prevent exposure to air borne bacteria, and the ice scoop on the wall was placed in a holder with sitting water. This failure had the potential to place residents at risk for infections, illnesses, and bacteria due to unsanitary conditions. Findings include: An observation on 11/9/2022 at 8:46 a.m. of the ice chest located on the 600-hall revealed brown, red, and black substances on the top, inside, and outside of the ice chest. There were two disposable clear cups located in a zip bag connected to the ice chest that were undated and used to scoop ice for resident cups. The bottom of the ice chest had black or grayish growth occurring around it above the basin catching the water. A white blanket under the ice chest was soiled with brownish debris. The third tier of the cart was found to have brown spots and dirt. In an interview on 11/9/2022 at 8:47 a.m. with LVN- O, it was revealed that CNAs were responsible for cleaning and refreshing the ice chest with fresh ice as needed. He said that the ice machine was in the room where food was served, near the nursing stations for the 500 and 600 halls. An observation on 11/9/2022, at 8:55 a.m. of an ice machine located in the nourishment room located on the 600 hall revealed a dried, white powdery, chalky substance caked around the inside of the ice bin. A large ice scoop lying on top of an ice machine, uncovered, and an ice scoop located to the right of the machine inside a scoop holder sitting in water. In an interview with the administrator, on 11/9/2022 at 9:30 a.m. it was revealed that she expected the staff working in the hall to clean the ice chest as needed. She stated that she would have them clean the ice chest and refill it with ice while she reviewed facility policy on hydration carts and cleaned the ice machine. The administrator stated that residents could become ill from receiving ice from the dispenser's that were not clean and sanitized In an interview on 11/9/2022, at 2:45 p.m., HK A revealed that he was responsible for cleaning the outside of the ice machine located in the nourishment room. He does not know who was responsible for cleaning the inside. In an interview on 11/10/2022, at 8:20 a.m. with Housekeeping Supervisors (HKS), it was revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 17 of 18 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that housekeeping staff are not responsible for cleaning the ice chest located on the 600 hall. She stated that housekeeping staff are responsible for cleaning the outside of the ice machine daily. She said that it was the job of the maintenance department to clean the inside of the ice machine. In an interview on 11/10/2022, at 8:30 a.m. the Maintenance Director (MD) stated that he was responsible for cleaning the inside of the ice machine once a month, per the manufacturer's manual. MD stated that he cleaned the caked white chalk substance located in the ice machine today after being notified by the administrator. He claimed to have cleaned and disinfected the ice machine with an Auto Chlor disinfectant solution. MD stated that it was critical to keep the ice scoop covered to avoid exposure to the environment and the growth of bacteria, which could put residents at risk of illnesses and infections. The maintenance director stated he had not noticed anything wrong with the ice machine until it was brought to his attention. In an interview on 11/10/2022 at 10:10 am, CNA -F revealed that she did not observe blackish buildup on the ice chest while on shift. She stated that she has refilled the ice chest with fresh ice when needed. She stated that she did not refill the ice chest on 11/09/2022 and 11/10/2022. She said that when she changes the ice, she cleaned with bleach wipes inside and out, then refills with ice. She denied observing water sitting in the bottom of the scoop holder that held the scoop she uses for ice refills. In an interview with ADON on 11/10/2022 at 12:15 p.m., she revealed she expects the CNAs to clean the ice cart and chest when they are visibly soiled, as the CNAs are the staff that refresh the ice chest with ice when needed. She stated that residents receiving ice from the machine could be at risk of infection and illness if it is not cleaned and sanitized. ADON stated that she had not observed the ice chest until it was brought to her attention by DON and the administrator. In an interview with the DON on 11/1020/22 at 12:20 p.m., she revealed that she expects CNAs to clean the ice chest when it is visibly soiled. She stated that she does not inspect the ice chests in each hall used for hydration at the facility. She stated that she did not observe the blackish-gray substance on the bottom of the ice machine or spilled residue on top until she was notified by the administrator. She stated that she took the ice chest to the kitchen for sanitation. She stated that staff have been trained on the proper sanitation of the ice chest and the protocol of taking the ice chest to the kitchen for sanitation when it is visibly soiled. In a second interview with the Administrator on 11/10/2022 at 12:30 p.m., revealed the health care staff were in charge of cleaning the ice chest. She stated when the ice chest was visibly soiled with stains and spots, it should be taken to the kitchen for sanitation before being refilled and returned to the hall for resident service of ice. She stated that the ice chest has been replaced with a new one, and scoops have been ordered. Review of the facility's Manufactures [NAME] and work log report dated 11/09/22 revealed a list of days that the machine was last cleaned by the MD by disinfecting the machine inside, clean filter and coils once every 30 days. In an interview with MD revealed that the facility doesn't have a policy for how often the machine should be cleaned FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675969 If continuation sheet Page 18 of 18